Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DE00009615 | WA |
NPI | 1114092764 |
---|---|
Provider Name | Laura Cardenas |
First Address | Tacoma, WA 98409-4528 |
Second Address | Tacoma, WA 98409-4528 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 08/07/2007 |